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. 2024 Mar;31(3):1623-1633.
doi: 10.1245/s10434-023-14711-w. Epub 2023 Dec 10.

Long-Term Patient-Reported Arm Symptoms in Breast Cancer Survivors

Alison Laws  1   2   3 , Mirelle Lagendijk  4 , Samantha Grossmith  1 , Melissa Hughes  2 , Nancy U Lin  2   3 , Elizabeth A Mittendorf  1   2   3 , A Heather Eliassen  5   6 , Tari A King  1   2   3 , Laura S Dominici  7   8   9
Affiliations

Long-Term Patient-Reported Arm Symptoms in Breast Cancer Survivors

Alison Laws et al. Ann Surg Oncol. 2024 Mar.

Abstract

Background: Understanding long-term arm symptoms in breast cancer survivors is critical given excellent survival in the modern era.

Methods: This cross-sectional study included patients treated for stage 0-III breast cancer at our institution from 2002 to 2012. Patient-reported arm symptoms were collected from the EORTC QLQ-BR23 questionnaire. We used linear regression to evaluate adjusted associations between locoregional treatments and the continuous Arm Symptom (AS) score (0-100; higher score reflects more symptoms).

Results: A total of 1126 patients expressed interest in participating and 882 (78.3%) completed the questionnaire. Mean time since surgery was 10.5 years. There was a broad distribution of locoregional treatments, including axillary lymph node dissection (ALND) in 37.1% of patients, mastectomy with reconstruction in 36.5% of patients, and post-mastectomy radiation in 38.2% of patients. Overall, 64.3% (95% confidence interval [CI] 61.1-67.4%) of patients reported no arm symptoms, 17.0% (95% CI 14.7-19.6%) had one mild symptom, 9.4% (95% CI 7.7-11.5%) had two or more mild symptoms, and 9.3% (95% CI 7.6-11.4%) reported one or more severe symptoms. Adjusted AS scores were significantly higher with ALND versus sentinel node biopsy (β 3.5, p = 0.01), and with autologous reconstruction versus all other breast/reconstructive surgery types (β 4.5-5.5, all p < 0.05). There was a significant interaction between axillary and breast/reconstructive surgery, with the greatest effect of ALND in those with mastectomy with implant (β 9.7) or autologous (β 5.7) reconstruction.

Conclusions: One in three patients reported arm symptoms at a mean of 10 years from treatment for breast cancer, although rates of severe symptoms were low (<10%). Attention is warranted to the arm morbidity related to both axillary and breast surgery during treatment counseling and survivorship.

Keywords: Arm symptoms; Breast cancer; EORTC QLQ BR23; Lymphedema; Pain; Patient-reported outcomes; Survivorship.

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